Immune checkpoint blockade in solid organ tumours: Choice, dose and predictors of response

Br J Clin Pharmacol. 2020 Sep;86(9):1736-1752. doi: 10.1111/bcp.14352. Epub 2020 Jun 5.

Abstract

Immune checkpoint blockade has transformed outcomes across solid organ tumours. Monoclonal antibodies targeting the negative inhibitory cytotoxic T lymphocyte-associated protein 4 and programmed-death 1/programmed death-ligand 1 axis can lead to deep and durable responses across several tumour streams in the advanced setting. This immunotherapy approach is increasingly used earlier in the treatment paradigm. A rapidly evolving regulatory, reimbursement and drug development landscape has accompanied this novel class of immunotherapy. Unfortunately, only a small proportion of patients respond meaningfully to these agents. Here we review how the underlying tumoural genomic, histological and immunological characteristics interact within various patient phenotypes, leading to variations in response to checkpoint blockade. Concurrently, we outline the clinical trial and real-world evidence that allows for appropriate selection of agent, dose and schedule in solid organ malignancies. An exploration of current trends in basic and translational research in immune checkpoint blockade accompanies a commentary on future clinical directions for checkpoint blockade in oncology.

Keywords: checkpoint blockade; cytotoxic T lymphocyte-associated protein 4; genotype; immunotherapy; pharmacology, phenotype; programmed death 1; programmed death-ligand 1.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • B7-H1 Antigen
  • Humans
  • Immune Checkpoint Inhibitors
  • Immunotherapy
  • Neoplasms* / drug therapy
  • Programmed Cell Death 1 Receptor*

Substances

  • B7-H1 Antigen
  • Immune Checkpoint Inhibitors
  • Programmed Cell Death 1 Receptor